Provider Demographics
NPI:1649818121
Name:HERBERT, MONIQUE ROYAL
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ROYAL
Last Name:HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21145 SPRING PLAZA DR APT 2320
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-1443
Mailing Address - Country:US
Mailing Address - Phone:832-296-1771
Mailing Address - Fax:
Practice Address - Street 1:21145 SPRING PLAZA DR APT 2320
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-1443
Practice Address - Country:US
Practice Address - Phone:832-296-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor